Monday, December 18, 2017

OCMA Blog

Call to Action from CalOptima Regarding Duals Demonstration

Dear Orange County Physicians:

CalOptima is measuring physician interest in a direct contract model for the dual-eligible demonstration that will launch in Orange County in April, 2014.  If there are not enough physicians interested in the direct contract model, it may be difficult for the CalOptima board of directors to support the model.  See the "Call to Action" below that CalOptima issued to the physician community.  As always, if you have any questions or comments, please contact us.

 

Thomas C. Kockinis, MD                                                   Robert McCann, MHA

President                                                                           CEO / Executive Director


 


Thinking About the Duals Demonstration? 
We Want to Hear From You!


The time for you to respond is now! The CalOptima Board of Directors is exploring the interest level of a direct contracting option with CalOptima for Cal MediConnect (also called the Duals Demonstration). Based on the interest level of the Orange County physician community, the CalOptima Board may grant authority to make this new option available.
 
If approved, the direct network will be based on managed care principles, providing support for your patients who may be difficult to manage through: coordinated care, case management, physical and mental health coordination, as well as home and community-based support services.
 
We need to hear from physicians who are interested in contracting directly with CalOptima, as the window for measuring interest is narrowing. In order for the model to be viable, a substantial number of physicians need to indicate their desire to participate. Currently, we do not have enough physicians displaying an interest to proceed with this option.
 
Orange County is one of eight California counties selected to participate in Cal  MediConnect. With Cal MediConnect, Medicare patients who are 21 years of age or older receiving full Medi-Cal benefits will have the option to transition from fee-for-service Medicare to this Duals Demonstration no sooner than April 1, 2014.
 
If you are a provider interested in directly contracting with CalOptima for this demonstration, please contact our Provider Relations department at 714-246-8600 or providerservices@caloptima.org to let your voice be heard and receive additional information about your contracting options. 

 


OCMA Member Update on Dual Eligibles Demonstration Project

February 25, 2013

 

Over the last 8 months as CalOptima has been building the foundation for the duals demonstration in Orange County, the OCMA has worked consistently and diligently to represent the interests of physicians and their patients.  The critical decision during this early stage of the demonstration was CalOptima board approval of a health care delivery system to serve the duals patients.

Click here for detailed background information.

 

The OCMA strongly advocated that individual physicians, currently serving the duals patients, be included in the delivery system.  A number of these physicians see their duals patients through Medicare Fee-for-Service, and it is important that duals patients continue to have access to their current physicians.

 

OCMA sent a letter to the CalOptima CEO outlining the reasons for the individual contract option.  This letter is the culmination of months of work and summarizes the many points we carried to individual CalOptima board members and their senior staff.  

Click here for the letter to sent to the CalOptima CEO on behalf of OCMA. 

 

We are very pleased to inform our members that the CalOptima board approved a health care delivery system that will include the individual physicians.  At the February meeting of the board, they considered a number of options and, in the end, agreed to develop a network model that will offer an individual contract option to physicians.  

Click here for the approved actions that were passed by the CalOptima board.

 

There remain a number of other important decisions relative to the duals demonstration, but we have achieved the major milestone noted above.  The OCMA will continue to be an active participant in the duals demonstration, decision-making processes and will continue to update the membership as we reach other critical decision points.


OCMA Needs Your Help with an Important Survey Regarding Dual Eligibles

Your participation is needed! Please consider taking a short, 10 question survey regarding the dual eligibles demonstration project.

Those who participate in this survey may enter to win one of three $100 Visa gift cards. By leaving your name at the end of the survey, you will be entered in the drawing! OCMA staff will contact the winners on or before February 7, 2013. 

The CalOptima board of directors is scheduled to make a critical decision regarding dual eligible patients (eligible for both Medicare and Medi-Cal) in Orange County at their February 7 board meeting. The decision could impact many physicians and their dual eligible patients. Your immediate input is necessary.

 

The OCMA has been working with CalOptima to advocate that the board adopt a very open health care delivery model for the duals patients; a delivery model that includes contracted health plans and individual physicians, via individual contracts. The broad health care delivery model will allow for patients to continue seeing their individual physician even if that physician is not affiliated with a CalOptima health plan for the purposes of Medicare managed care.

 

In order to effectively advocate for the physicians providing Medicare services, we need accurate and current information to share with the CalOptima staff and board members. This survey will enable us to provide a substantial portion of the important information that we need. The CalOptima board is uncertain, at this time, on the type of health care delivery model they will utilize for the duals patients in Orange County, so your immediate response is requested and will be of great value. Thank you for your time and participation.


For a more detailed update on the duals demonstration in Orange County, please go to the OCMA web site under the Local Advocacy section.

 

To continue to the survey, click the link below.


Survey Link: 

https://www.surveymonkey.com/s/CB9QHJR


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